Articles for therapists and counsellor about CBT - Cognitive Therapy. These posts are intended to help the beginning CBT practitioner and also provide food for thought for experienced cognitive therapists. Provided by UKCP Central London therapist and accredited CBT practitioner and supervisor Tim LeBon.

Wednesday, 25 November 2015

This excellent workshop wasn't intended as a complete training in DBT, but rather as a way to understand how an experienced practitioner could take parts of the DBT model and incorporate it into their practice. It worked for me! Here are the top 10 things I learnt from the course

1) DBT is Dialectical

Dialectical means accepting and working with opposites and apparent contradictions

There is a thesis, an antithesis and then a synthes which includes truth from both.

For example, if thethesis is "I need to change!".

and the antithesis is "I can't change".

thesynthesis could be "Change is difficult. What I have tried so far hasn't worked. I need to work on skills to change, even though this will be difficult".

If a client wants to practice midfulness (the thesis) but has a cold and says "I cant do mindfulness today because I have a cold" then as a therapist you might helpful suggest (the synthesis) "Your cold presents you with a great opportunity to practice mindfulness when its harder"

2) DBT is Behaviorial

The focus is on behaviours that need to be changed for the client to achieve their goals. This provides a very clear focus and can make the complicated and complex much simpler
The therapy focuses on

What am I doing causing me and others problems and what can I do differently?

Below is a summary of some behavioural principles which can help guide a skilful therapist

Form a plan to change unhelpful behaviours

Get whole lot of possible solutions

Give them skills ask them to choose like a smorgasbord then ask which appeals most

Look at obstacles and how to overcome them

Shape and reward desired action - if they have done something positive, praise this

3) DBT is Skills-based

Forming a plan is a good start, but many people don't have the skills to carry this out effectively. There is a large element of skills training in DBT and this is usually done in Skills groups

where participants learn to decrease problematic and unskillful behaviours.

4) A possibly lengthy assessment phase

DBT is a big investment for both client and therapist. It is fitting then that some time is given for the potential client to think about whether to commit to DBT.
A Contract usually a year involving a lot. Asssement will explore motivation and behaviours they want to change. This phase can last up to 6 weeks

5)Telephone coaching is part of the deal

In a DBT group, the client is offered telephone coaching when they need it. This is specifically for help when they are in crisis. The client will form a crisis plan which they have with them
If they ring, you go through the crisis plan with them
"Get them to breathe then walk through plan"

6)Validation and Acceptance of the client

Although change is the desired outcome, validation is an extremely important prerequisite for change

These range from showing an interest, to validating their emotions and behaviours "It's normal to feel anxious before coming to see a therapist." You are accepting the person, but that doesn't mean you are endorsing unhelpful behaviours.

7) Use of Chaining as a formulation method

This is similar but not identical to CBT's "Hot Cross Bun" or "maintenance cycle" formulation is called "Chaining" in DBT.

Chaining is actually fairly straightforward and involves the following steps :-
Ask

When did you first know that the problem behaviour would arise?

If you were in situation again what would you do differently?

What stopped you this time?

What made you vulnerable at this time

What happened when you stopped

What are the consequences?

What can we learn from this?

Then ask them to describe the sequence as if telling an actor how to play the part. It needs to be spefific. You are finding out the chain of antecedants, behaviours and consequences in terms of thoughts, feelings, urges and behaviours.

8) The Role of individual sessions

A lot of the skills learning takes place in the group sessions, but individal sessions are important too. In these you make list of target unhelpful behaviours to reduce

In each session work through list in each area hierarchically

They bring in diary/ Your job is to keep them "on the hook"

9) Wise Mind

DBT makes the helpful distinction between Logical. Emotional and wise mind
Logic is great - but what it would be like to be just in logical mind, like Mr Spock?
We would lose a large part of what it is to be human, what motivates us and what makes us individual. Fear keeps us safe. Anger stops people treating us like a doormat

Yet emotions can get us into a lot of trouble.

We need emotions - but in moderation

Wise mind can moderate emotions, its the synthesis of logical mind and emotional mind.

Here is an exercise that might help you locate your own wise mind
Think of a dilemma

Start with facts and logic

Then think about the emotions and desires connected with the dilemma

Imagine falling down a well taking all the facts and feelings with you. At the bottom is
a trap door. Through this trap door is your wise mind, which takes into account logic and feelings. Go through the trap door? What does wise mind tell you is right for you?